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New Recommendation for Cervical Cancer Screening Using HPV Test Alone

Authors champion health advantages of HPV test over Pap smear

Approximately 80 million U.S. women 25 to 65 years of age should be screened periodically by their health care providers for cervical cancer. At present, the standard way to do that is with a Pap smear alone or with co-testing using both a Pap smear and a human papillomavirus (HPV) test.

Clinicians who care for those women have received new interim guidance about the health advantages of using the HPV test alone as the primary screen to find cervical cancer or its precursors. Under the new guidance, the Pap smear, which dates back more than 80 years, would still be used for follow-up tests if an HPV test is positive. In addition, the Pap smear will still be used for primary screening of women under the age of 25.

The need for guidance about using the HPV test was triggered last April when the FDA approved such a test for use in primary cervical cancer screening. The new guidance, written by a group of cervical cancer screening experts led by University of Alabama at Birmingham gynecologic oncologist Warner Huh, MD, was published January 8 in three journals: Gynecologic Oncology, Obstetrics & Gynecology, and the Journal of Lower Genital Tract Disease.

“Because of equivalent or superior effectiveness,” the guidance states, “primary HPV screening can be considered as an alternative to current U.S. cytology-based (i.e., Pap smears) cervical cancer screening methods.” The authors note that current guidelines still recommend Pap smears alone or co-testing with a Pap smear and an HPV test for cervical cancer screening. However, those guidelines –– from 2011–– predate more recent clinical studies of HPV testing.

Further, according to the new guidance, women who receive a negative HPV test result from their primary screening have a greater reassurance of a low risk for a future cervical cancer precursor lesion compared with women who have a negative Pap smear test in their primary screening. This lower rate of false-negative results is a key benefit of the HPV screening, the authors say.

“The scientific evidence clearly demonstrates that primary HPV testing outperforms cytology or Pap as a screening test,” Huh points out. “This has been confirmed from numerous European and Canadian studies as well as the ATHENA trial. There are going to be fewer false negatives with HPV, and arguably, we have been using a less sensitive test for screening for a while now.”

Huh adds: “Pap smears miss a fair number of adenocarcinomas. We don’t want a test that will miss disease.”

Under the new guidance, if the HPV test is positive for HPV types 16 or 18, colposcopy is the next step. If the HPV test is positive for one of 12 other HPV types, a Pap smear (cytology) is the next step. If the result of that Pap test is ≥ ASC-US (atypical cells of undetermined significance), the patient would be referred for colposcopy. If the Pap test is NILM (negative for intraepithelial lesion or malignancy), the patient would be scheduled for a follow-up visit in 12 months.